Antidepressants for Hot Flashes
How It Works
Selective serotonin reuptake inhibitors (SSRIs) affect the brain's use of a neurotransmitter chemical called serotonin, which is thought to have a role in regulating body heat.1 Increased serotonin use by the brain can also improve perimenopausal mood swings and irritability.
Venlafaxine affects the brain's serotonin and norepinephrine levels. How it affects hot flashes is not known. Mood may also improve with venlafaxine use.
Why It Is Used
Select antidepressants are used to treat hot flashes affecting menopausal women. They may also help with irritability, depression, and moodiness. They can be used before and after menopause as a symptom treatment alternative to hormones (birth control pills or hormone replacement therapy [HRT]).
Antidepressant therapy helps many men and women who have hot flashes from cancer treatment. But if you take tamoxifen to treat your cancer, you need to avoid certain antidepressants. Talk to your doctor about what medicines for hot flashes are right for you.
Do not take venlafaxine if you:
How Well It Works
Studies have shown that certain antidepressants may help relieve hot flashes.2
Possible SSRI side effects include:
Rare SSRI side effects include:
Time-released formulations and lower doses reduce the risk of side effects.
Possible venlafaxine (Effexor) side effects are similar to those of SSRIs. Venlafaxine can also cause:
Other more serious side effects are rare but can include allergic reaction, fast heart rate, nausea, dizziness, anxiety, blurred vision, insomnia, increased blood pressure, and seizures. Because venlafaxine can increase blood pressure, it is used with caution in women with high blood pressure, heart failure, or glaucoma.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
What To Think About
Using antidepressants to treat menopause symptoms is considered an off-label use for these medicines.
The side effects most commonly reported with paroxetine (such as Paxil) use for hot flashes were headache, nausea, and insomnia. About 58% of women reported side effects. (Interestingly, of women who were taking a placebo, about 53% also reported side effects. Similarly, about 43% of women taking a placebo reported a 50% or better improvement in hot flashes.)1
Further research is needed to determine the risks and benefits of long-term antidepressant treatment. But many people have used these medicines for long-term treatment of depression.
Never stop taking antidepressants abruptly. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping these medicines can cause headaches, nervousness, anxiety, or insomnia.
Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Before you take an SSRI, talk to your doctor about this risk.4
SSRIs and venlafaxine make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs or venlafaxine with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.5
eMedicineHealth Medical Reference from Healthwise
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